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Difficult Questions… for DURING a Hookup!

Difficult Questions… for DURING a Hookup!

You’ve made it! There is a real-life, in the flesh human in front of you and things are about to get hot… fast! The last thing you want to do right now is put a damper on the mood by unnecessarily stressing about HIV and STI risk or by making a move your partner hasn’t consented to. Sex should be hot! Fun! And we’re here to help keep it that way.  This is a longer post than the first in our series. But by taking 15 minutes now you can keep you and your future sexual partners safe and in the mood!

On Consent

Consent is the voluntary agreement an individual makes to engage in a sexual activity with another person. Sexual contact without consent is sexual assault. Period!

Anyone can be a victim of sexual assault, regardless of their sexual orientation, gender identity, or relationship status. To ensure that you are complying with the law while also keeping things safe, consensual, and fun for you and your partners,  consider asking yourself the following questions before you engage in sexual activity with someone else:

Is my sexual partner capable of providing consent?

Someone can’t provide consent if they are unconscious. Seems pretty obvious, no? But what if someone is drunk? This is a common question that many people have but are afraid to ask. So, if you’re not sure, you’re not alone. After all, the line between being someone being intoxicated but still capable of giving consent and intoxicated but incapable of giving consent can be challenging to pin down. But just because it’s challenging doesn’t mean you don’t have to act within the law. Here are a few considerations that may prove useful in situations where you and your partner are drunk and considering engaging in sexual activity:

First, take a step back. Do you truly believe – and not just because you’re horny – that this person is capable of providing clear, affirmative consent to sexual activity? This requires more than just a slurred “yes.” The person must demonstrate that they are capable of understanding the potential risks and consequences associated with the sexual activity in question. If there is any question, then don’t do it! The potential harm to both you and your partner is not worth it.

Second, do you believe that YOU are in a state where YOU’RE capable of making that determination? In circumstances where both individuals are drunk, the onus is on the person initiating sexual activity to ensure the other person is capable of providing consent. The fact that you were drunk too isn’t a sufficient defense. If YOU initiated the sexual contact then YOU are the one responsible for ensuring that your partner is capable of consenting.

Taking a step back from drinking, it’s also important to remember that consent is also invalidated if it was obtained through the abuse of trust, power or authority. If you have a relationship with someone where you could be considered to be in a position of trust, power, or authority over them, you need to take extra care to ensure that you have in no way used that position to obtain consent which otherwise would not have been given.

Has my sexual partner provided clear, affirmative consent to sexual contact?

In discussions about consent, we often hear the phrase “no means no.” And although that is true, in Canada the absence of “no” is not enough to establish consent. Instead, people must clearly indicate that they are consenting to the sexual activity in question. So, instead of “no means no,” think “yes means yes.” Anything short of a clear, affirmative yes – whether through word or conduct – does not meet the requirements for consent.

Have I received consent to do ______?

Just because someone agreed to get naked with you in bed or atop the kitchen the table doesn’t mean you can simply go down on them without checking in to make sure it’s okay for you to do that. You need to ask for consent for each type of sexual activity you want to engage in. If you don’t want to interrupt the flow by stopping and having a conversation before each new sexual activity you engage in with your partner, make sure you have a thorough conversation before sex starts to establish what types of sexual activities each of you are consenting to for this particular sexual encounter. Otherwise, a simple, “Is it okay if I fuck you?” takes 3 seconds to say. So, no excuses. Ask before you do.

Two other short but crucial things here. 1) Consent must be obtained each time you have sex. Just because someone was “up for it” when you got home from the bar last night doesn’t mean you have automatic consent from them to initiate sex the next morning. Consent must be obtained each time. 2) If your sexual partner consented to anal sex with a condom, then that’s what they’ve consented to: anal sex WITH a condom. If you decide to remove the condom without asking your partner, the consent they initially provided is invalidated and you are committing sexual assault. So, general rule – ALWAYS ask.

Is my partner continuing to display clear signs of ongoing consent?

Just because someone said “yes” to something 10 minutes ago, doesn’t mean they have to continue. If for any reason, at any time, you or your partner want to stop something you had previously consented to, that is your right – period. Additionally, if someone becomes unconscious, passes out, or gives you any indication that they are no longer capable of providing clear, affirmative consent, any consent they provided earlier is no longer valid and you must stop all sexual activity you are engaging in with that person immediately.

You might feel that some of these questions can interrupt the rhythm of your sexual encounter – and the pleasure that comes with it. But trust us, there’s nothing sexy about sexual assault – intentional or not. So, look out for yourself and your partner and make sure everyone’s on the same page. Consent is sexy!

[Additional Note: For more information on Consent Law in Canada, LEAF provides a great summary here and the Globe and Mail did some excellent reporting on the impact of alcohol on sexual assault cases! The criminalization of HIV non-disclosure is also rooted in Canadian consent law. To read more about this topic, visit our HIV Disclosure section or hop on over to the Canadian HIV/AIDS Legal Network].

 

HIV and STIs: Risk and Prevention

You and your partner have had the conversation. You’ve both consented to having sex – and have discussed what types of sex you are each agreeing to having. But there’s still an elephant – or elephants – in the room.

For years – decades really – GBTQ men have been led by those in public health to equate sex with fear. “What about HIV?!” And more recently in Alberta, “Syphilis!” The truth is, as is the case with many other great things in life, sex comes with some potential downsides – and HIV and STIs are right up there near the top of the list. But knowledge is the great antidote for fear and stigma! Read on to learn some questions you can ask to take control of your own sexual health and protect you and your partner.

Establishing a Baseline

[Note: In this post, unless otherwise specified, when we talk about “STIs” we are specifically referring to bacterial STIs: syphilis, gonorrhea, and chlamydia]

It’s hard to know which prevention methods you might want to use if you don’t know what risks you or your partner might be exposed to during a sexual encounter. Here are some questions that will help you determine if HIV or STIs are potentially in the mix:

To the best of your knowledge, what is your current HIV status?

If someone says they are HIV Negative… proceed to “Do you currently have any STIs that you’re aware of?”

              But if someone says they are HIV Positive…

Have you maintained an undetectable viral load for at least six months?

If someone says “yes,” you’re golden. We now know that when an individual who is HIV positive maintains an undetectable viral load for six months, and continues to take their medication as prescribed, they will not transmit HIV to their partners sexually.

If someone says no, then you will want to consider which HIV prevention methods you might want to use as there is a possibility of being exposed to HIV.

Do you currently have any STIs that you’re aware of?

If someone says no… proceed to “When were you last tested?”

If someone says yes, then you will want to consider which STI prevention methods you might want to use as there is a possibility of being exposed to an STI.

When were you last tested for HIV and/or STIs?

If someone says they were never tested for HIV and/or STIs then you might want to determine why. Is it because they’ve never had sexual contact with someone else before? In that rare circumstance, then you’re probably good to go, with little or no risk of being exposed to HIV or STIs. However, if they say they’ve never been tested but they HAVE had sexual contact with someone else, then they likely aren’t aware of their HIV and/or STI status and you should proceed under the assumption that HIV and STIs could be in play.

But if someone provides any other answer…

Is there any chance that you might have been exposed to HIV or an STI at any point between now and about six weeks BEFORE your last HIV and/or STI test?

               We debated how best to ask this question. Here’s our reasoning behind it:

As you may know – and which we will talk about in greater detail in part three of this series – different STIs have different “window periods.” The window period refers to how long it can take after a potential exposure to an infection for a test to return an accurate result. Here’s a breakdown of how long it can take to return an accurate result for HIV, syphilis, gonorrhea, and chlamydia as per the BC CDC’s Smart Sex Resource:

HIV: 95% of tests are accurate at 6 weeks but it can take up to three months to return a final result

Syphilis: 3-4 weeks

Gonorrhea: Most results are accurate after seven days

Chlamydia: Most results are accurate after two weeks

Therefore, if someone tested negative for HIV, syphilis, gonorrhea, and chlamydia and has not had any potential exposures since six weeks before that test, you can be almost certain that they are negative for both HIV and these three common bacterial STIs.

On the other hand, if someone responds that their last potential exposure was two weeks before their last test, then you can know that they probably don’t have gonorrhea or chlamydia but you can’t be as certain about syphilis or HIV. And of course, if the potential exposure was the day before their last test or anytime after, then they cannot say for sure that they are negative for HIV or any of these STIs.

[Additional Note: There are other questions that you can ask to increase certainty regarding your partner’s status. For example, where were they tested and what types of tests did they receive (i.e. was it just blood-work or did they also receive an oral and rectal swab?). The truth is, you can drill down further into most of the areas covered by the questions above – especially if you’re interested in gauging the likelihood of rarer circumstances being at play. But we believe these questions are easier for you to remember and will go a long way to support your efforts to establish a baseline regarding the HIV and STI status of you and your sexual partner.]

Understanding Risk and Prevention

What level of risk am I comfortable with?

Maybe you’ve gone through the list of questions in the previous section and you’re nearly 100% certain that there is zero (or near-zero) risk that HIV or STI transmission could occur during your sexual encounter. In that case, you might decide that you do not need to use any HIV or STI prevention methods beyond knowing your and your partner’s status. And that’s okay – especially if you feel confident in your risk assessment.

On the other hand, maybe you’ve gone through the questions above and you’re less than 100% certain that there is zero (or near-zero) risk that HIV or STI transmission could occur during your sexual encounter. In that case, you might still decide that you don’t want to use additional HIV or STI prevention methods. And that’s okay too – as long as you and your sexual partner are aware of the potential risks involved.

Or maybe, regardless of where the questions above have led you, you’d just feel a lot more comfortable if you took a few simple precautions to lower the risks involved.  The questions in the next two sections will look at What types of sexual activity place you at risk for HIV and STI transmission and some of the prevention options you can take to lower that risk.

HIV & Oral Sex

In most cases, the risk of HIV being transmitted through oral sex is negligible, meaning the risk is so low that it’s not worth considering. However, as per the Terrence Higgins Trust, the risk can increase under certain circumstances:

If the person giving oral sex has cuts, sores or abrasions in their mouth or gums

If the person giving oral sex has a sore throat or an infection in the mouth or throat

If the person receiving oral sex has cuts, sores, or inflammation in the genital area

Some questions you might ask to determine and prevent the risk of HIV transmission posed by oral sex are:

Is there any chance that either me or my partner are HIV positive AND have an detectable viral load?

Regardless of the scenario, there is only a risk of HIV transmission if the person giving or receiving oral sex is HIV Positive AND has a detectable viral load. This demonstrates the importance of the questions in the “Establishing a Baseline” section. After all, if you and your partner are either 100% certain of your HIV negative status or are HIV positive and have an undetectable viral load, there is no risk of transmission.

But if there is a potential chance that you or your partner may be HIV positive and are unaware or have a detectable viral load, you’ll want to ask…

Are any circumstances present that would increase the risk of HIV transmission through oral sex?

If neither you nor your partner are experiencing any of the circumstances listed earlier which increase the risk of HIV transmission via oral sex (i.e. cuts or sores in the mouth or genital area) then the risk of HIV transmission via oral sex is extremely low and likely negligible.

However, if either you or your partner ARE experiencing any of the circumstances which could increase the risk of HIV transmission via oral sex…

Which steps can I take to lower the risk of HIV transmission during this encounter?

HIV prevention tools that would help lower the risk of HIV transmission via oral sex are:

Using barrier methods such as condoms and dental dams

You or your partner being on PrEP. When PrEP is used daily as prescribed, it provides near 100% protection against HIV transmission

We understand that there are a lot of things to think about when it comes to sex. We get that not everybody wants to go through a checklist every time they give a blow-job or get eaten out. And we also get that the use of condoms or dental dams for oral sex isn’t realistic for many. But if uncertainty has been putting a damper on your sex drive, these few questions can help you feel more knowledgeable and freer when having sex.

HIV & Penetrative Sex [Anal | Vaginal | Frontal]

While oral sex requires a particular set of circumstances to be present to pose significant risk of HIV transmission, that is not the case with penetrative sex. Whether you’re having anal sex, vaginal sex, or frontal sex, each type of penetrative sex carries a risk of transmission. To help mitigate that risk, you can ask yourself the following questions:

Is there any chance that either me or my partner are HIV positive AND have an detectable viral load?

If the answer is truly “no” then neither you or your partner are at risk of contracting HIV through penetrative sex

But if the answer is yes…

Which steps can I take to lower the risk of transmission in this circumstance?

There may be circumstances that increase the probability of HIV transmission through penetrative sex. Some example of scenarios where the risk of HIV transmission might be higher are:

Anal sex is generally considered to pose a higher risk of transmission than vaginal or frontal sex

Transmasculine individuals who are on testosterone may experience dryness in the front hole, increasing the risk of HIV transmission

If either partner has an STI, that can increase the risk of HIV transmission occurring.

Whether any of these circumstances are present or not, some HIV prevention tools that would help lower the risk of transmission via penetrative sex are:

Using barrier methods such as condoms. Both male and female condoms provide near 100% protection against HIV infection WHEN used correctly. You want to ensure that the condoms have not expired, that they are “put on” correctly, and that adequate and appropriate lubrication is used

You or your partner being on PrEP. When PrEP is used daily as prescribed, it provides near 100% protection against HIV transmission

But the common theme throughout this section is the importance of knowing your status. If you are 100% certain that you and your partner are HIV negative or are HIV positive AND have an undetectable viral load, there is no risk of HIV transmission through sexual transmission – period.  If you don’t know this for sure, then you are potentially at risk for HIV infection and should take the time to consider what level of risk you are comfortable with and what prevention methods you could use to lower that risk.

[Additional Notes: 1) Some people use other strategies to lower the risk of HIV transmission such as serosorting (selecting partners based on HIV status) or seropositioning (choosing to bottom or top depending on your partner’s perceived HIV status). But given what the know about the impact of an undetectable viral load – and the fact that these methods aren’t extremely effective, we recommend sticking to methods that are proven effective such as knowing your status, accessing treatment and becoming undetectable if you are positive, accessing PrEP if you are HIV negative, or using barrier methods such as condoms.

2) The Prevention Access Campaign’s Consensus Statement, which expresses that HIV positive individuals who are undetectable DO NOT transmit HIV to their partner’s sexually only covers the sexual transmission of HIV and does not necessarily claim that HIV is untransmittable through other circumstances such as sharing needles].

STIs [Syphilis | Gonorrhea | Chlamydia]

[Note: This section will focus specifically on the bacterial STIs syphilis, gonorrhea, and chlamydia. For more information on other STIs, visit the BC CDC’s Smart Sex Resource]

If you’ve hit all of the main points in the “Establishing a Baseline” section of this post, you should have a pretty good idea as to whether or not there is a risk of STI transmission between you and your partner. If you’re not able to say with certainty that you both do not have one of these STIs, you’re going to want to understand how they’re transmitted so that you know how to prevent transmission:

Syphilis: Skin-to-Skin contact – fluids from a syphilis lesion

Syphilis sores can be found on the lips, in the mouth, on or around the penis, the vagina or the front hole, in addition to on or around the anus or in the rectum. If any of these areas of your body come into contact with a syphilis sore on someone else’s body, syphilis can be passed on to you and vice-versa. Therefore, syphilis can be passed on through any type of penetrative or oral sex, or any activity where the contact described above could occur.

Gonorrhea: Semen, vaginal or front hole fluids, rectal fluids

Gonorrhea can be passed on from one person to another any time that any of these fluids come into contact with the genital area, the anus or rectum, or the mouth or throat. Therefore, gonorrhea can be passed on through any form of penetrative sex in addition to oral sex. Unlike syphilis, however, it should not be transmitted just through skin-to-skin contact.

Chlamydia: Semen, vaginal or front hole fluids, rectal fluids

Chlamydia can be transmitted in the same ways as gonorrhea.

So, some questions you can ask in order to lower the risk of STI transmission are:

Is there any chance that me or my partner might have one of these STIs?

If you’re 100% certain that neither of you have a bacterial STI, keep in mind that there are still other STIs that can be passed on through sexual contact:

Herpes (HSV): Through skin-to-skin contact

HPV: Through skin-to-skin contact

Hepatitis A: Through fecal-oral contact, although transmission can occur through any type of sexual activity (and is most commonly contracted through contaminated food or water)

Hepatitis B: Through blood, semen, vaginal fluids, rectal fluids (although most Albertans have been vaccinated for Hepatitis B)

Hepatitis C: Through blood and fluids containing blood (Hepatitis C can be transmitted sexually and you should pay particular attention if you are engaging in sexualized drug use or rougher or prolonged sex where blood may be present)

But if there is the chance that one of you could have one of these STIs…

What potential STI prevention methods can I use to prevent transmission between me and my partner?

Barrier methods such as condoms, when used properly, are highly effective at preventing the transmission of gonorrhea and chlamydia as they block the fluids these STIs are present in from coming into contact with parts of your body that are vulnerable to infection such as the mouth and throat, anus, rectum, vagina, or front hole. Because of this, they are also an effective method of decreasing your risk of becoming infected by Hepatitis C (and B). Condoms and barrier methods can also provide protection against syphilis transmission but are not as effective as they are in regards to HIV, chlamydia, and gonorrhea given that syphilis can be passed on through skin-to-skin contact.

Wait! Isn’t there more? Unlike HIV prevention, which boasts multiple biomedical prevention tools, that’s not the case for bacterial STIs. And although some people may attempt to lower the risk of STI transmission through methods such as “pulling-out” before ejaculation or choosing to “top” instead of “bottoming,” these are not necessarily effective. So, the correct and consistent use of barrier methods such as condoms still remains one of the most effective ways to prevent the transmission of bacterial STIs.

[Additional note: If you are using sex toys, many of the considerations are the same. Has the sex toy been exposed to fluids that could contain HIV or STIs? Is it then touching a part of someone’s body that is vulnerable to infection? The use of barrier methods such as condoms when sharing sex toys is a great way to lower the risk of transmission. There are also other considerations like the proper cleaning of sex toys and ensuring you’re using the right lube. For more information on that, feel free to speak with our friends at the Travelling Tickle Trunk. They can help you pick out the right toy to enhance your pleasure and give you the information you need to keep you and your partner safe!]

And you’ve FINALLY made it to the end!

We get that this post contains a lot of information and that some of the suggestions might seem a little restrictive (I mean, who wants to use a condom for oral sex, right?). We also understand that there’s more to sex than “risk” and “prevention.” There’s also pleasure… intimacy… excitement! Sometimes in the grand balance of things, those things win out over something like the use of a condom. We get it!

And if you ever find yourself in that situation, we’ve got your back then too! So, check back next week for “Difficult Questions… AFTER a Hookup!” where we look at what happens AFTER a hookup if you happen to get a call from an STI Nurse!

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